As is the case with so many of the public-policy problems that befuddle Americans, our nation’s health care system is in dire need of commonsense reforms. Unfortunately, previous attempts to fix the broken health care system at the federal level such as the Affordable Care Act and Medicaid expansion during the pandemic have made the overall situation worse.

Because the odds of a sound reform proposal at the federal level seem lower than ever given the constant gridlock in the nation’s capital, it is time for the states to take the lead in pushing for reasonable reforms that will make high-quality health care more accessible and affordable.

Enter the American Health Care Plan: State Solutions, a policy study by the Heartland Institute that outlines nine simple steps to empower patients and health care providers, increase access to care, lower prices, raise quality, encourage innovation, and protect individual rights.

The 2024 version of the American Health Care Plan (AHCP) is a follow up to the 2021 edition, which focused entirely on national measures to lower health care costs, increase access to first-rate care, and introduce free-market forces to a health care system that has become excessively bureaucratic and overly dependent on a one-size-fits-all approach.

Specifically, the latest edition of the AHCP offers a handful of state-based reforms intended to reverse elements of federal health care overreach while reinvigorating the unique role of the states concerning several pressing health care issues.

First and foremost, states should address Medicaid expansion that has occurred under the Affordable Care Act (Obamacare) and the COVID-19 pandemic, which has resulted in a huge increase of waste, fraud, and abuse. States need to ensure that those on Medicaid are actually eligible for the program and those who no longer qualify transfer to Obamacare exchanges or private coverage.

Second, states should increase health care price transparency through the implementation of reference-based pricing. It is almost inconceivable that many patients still do not know how much a medical procedure or appointment will cost before the fact, however, that is still the case far too often.

Third, states should repeal outdated certificate of need laws, which are a remnant of a bygone era and stifle innovation. Instead of a government bureau determining if existing health care facilities can add beds or expand services, it would be much better if this was left to the invisible hand of the free market.

Fourth, states should strengthen the provider-patient relationship by protecting providers’ free speech rights and reforming the antiquated system of prior-authorization mandates. During the pandemic, we witnessed several instances of doctors being forced to bite their tongues concerning “alternative” treatment options that have since been proven to be effective. This must never happen again. Similarly, doctors should be trusted to provide their patients with the best treatment plans available, regardless of whether or not those treatments have received prior authorization from a health insurance company bureaucrat.

Fifth, states should ease restrictions on Direct Primary Care (DPC) agreements, a patient-friendly subscription-based model of health care. DPC agreements have the potential to revolutionize how health care is delivered in the years ahead and should be open to all Americans.

Sixth, states should expand access to telemedicine so patients can conveniently seek care and medical advice without the bother of making an in-person appointment. In today’s environment, obtaining an in-person appointment with a specialist can take months. By loosening restrictions of telehealth, especially for mental health services, patients would have access to their care providers more frequently and with much less hassle.

Seventh, states should expand Right to Try legislation, which allows terminally ill patients to access medications that have passed Phase One FDA safety trials but are not available on the general market. Sadly, far too many patients live with debilitating conditions that could be helped with experimental treatments that have not undergone the time-consuming and increasingly expensive process of FDA approval. Giving patients and their doctors greater choices in treatment options could literally save countless lives and relieve patients of needless suffering.

Eighth, states should expand existing interstate physician compacts in order to resolve the increasing shortage of care providers. With more doctors retiring than ever before and provider shortages increasing, states should allow providers to treat patients across state lines without having to spend years and large sums of money getting their medical license approved. This is especially relevant as telehealth becomes more prevalent and doctors are increasingly able to provide medical care via emerging technologies.

Ninth, states should contest federal overreach by applying for state waivers to liberate them from arduous federal regulations while spurring innovative and unique state-based solutions to common health care problems. It goes without saying that the particular problems one state faces might differ substantially from others. With that being the case, it makes sense to embrace federalism and let the states tinker with diverse solutions to their unique problems.

There almost never is one overriding solution to a system as complex as health care. Beware of those who claim that Medicare for All or any other single-payer system is a panacea. However, we know that when the states are left to their own devices and allowed to offer tailored solutions to the distinctive problems that plague their particular populations, best practices and innovative solutions to vexing issues usually lead to better outcomes for all.

Chris Talgo (ctalgo@heartland.org) is editorial director at The Heartland Institute.

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